Living a life in recovery

By BRENT AMBACHER | STR and LaSOR State Peer Recovery Support Specialist, LDH

(Note: Brent Ambacher is sharing his recovery story in honor of National Recovery Month, observed every September as a time to increase awareness and understanding of mental and substance use disorders and to celebrate the people who recover. Learn about recovery resources in Louisiana here.)

The last time I had a drink — April 29, 2012 — I didn’t even want one. After about 10 days of AA meetings, I’d heard enough to make me decide I was done, and had given up for good (I thought) about 72 hours earlier. The problem was, after 27 years of consistent and ever-increasing drug and alcohol use, my body wasn’t down with this plan. I was unable to hold down food or water, and had started vomiting blood.

Alcohol is one of the few substances that can actually kill you if you stop abruptly. I sort of knew this. I was fully aware that I was a hopeless alcoholic who hadn’t gone a single day without drinking myself to “sleep” in probably 10 years. But I wasn’t able to connect the dots. I was told I needed to go to the emergency department, but the prospect of waiting for hours in that condition was too horrifying to contemplate.

Brent Ambacher

So, instead of my usual vodka intake of more than a liter, I was sitting on my back porch, crying, sweating, shaking uncontrollably and trying to choke down a glass with a mixture of two-thirds beer and one-third honey.

I could not for the life of me understand how this was helpful, but I knew enough to know that I was in serious physical trouble and that a guy with 20 years of sobriety probably knew more than I did about quitting. The drink was his recipe. It took me two hours to get it down, but it worked. How does somebody end up the way I did — 46, jobless, divorced, broke, homeless and staying with my eldest sister?

Struggling to cope

I was a missionary kid who grew up in Hong Kong and moved back there after college. I’d been a successful photographer, journalist, advertising executive and spin doctor. I’d lived on three continents, married a beautiful, smart and talented English woman, spent nine years in London, moved to New York, traveled the world. I was SOMEBODY. But that was just on the surface.

Inside, I was desperately frightened that one of these days, everyone would figure out that I was a fake, with no talent, and that I didn’t deserve anything I had. I had also been struggling with anxiety and depression for as long as I could remember. Drugs and alcohol were my way of trying to cope with feeling like a failure and prop myself up so I could keep impressing everybody else.

I guess I thought if other people loved me enough, I’d be OK.

I wasn’t. I was a pathetic drunk and I was close to death.

Climbing back from the bottom

That was seven years — and an entire lifetime — ago. I had to start over, from the bottom. I delivered auto parts for a while, and then someone suggested I might look into becoming a Peer Recovery Support Specialist. I’d never heard of one, but I gave it a shot. Besides getting sober, it was the most important thing I’d ever done for myself.

I went to work at a treatment center and spent a little over two years helping people like me. Another person suggested I apply for a job that I never would have dared to try for, but they hired me — as the Statewide Peer for the STR Grant, here at the Louisiana Department of Health’s Office of Behavioral Health. Then they asked me if I wanted to try my hand at facilitating Peer Employment Trainings, so I said yes to that, too. I’ve learned that I don’t often know best what it is that I’m supposed to do next, but saying yes is usually the right idea.

I make about a quarter of what I used to. I don’t jet off for the weekend because I feel like it. But in return, I have so much more than money could buy me. I was able to be present and help nurse my father through the last four years of his decline from Parkinson’s and dementia, and I was at his bed when he died. I have a job where I’m allowed to be useful, and where the pain of my past can light a pathway forward for people who are looking for a way out of substance use and mental health challenges. 

And, for the last 2,600-and-something days, I haven’t needed a drink or a drug to be OK with myself. It sure seems like a good trade to me.

Candida auris: A new fungus among us

By DR. DAVID J. HOLCOMBE | Medical Director, LDH Region 6

Fungi, like bacteria, surround us.

These organisms — which include yeast and mushrooms —come in many forms, including Candida species, a fungus that is common and ubiquitous. Candida albicans, for example, is the causative agent of thrush, vaginal yeast and other skin infections, and can be easily treated. However, this is not true of a “new” fungus on the block, Candida auris.

A highly magnified view of Candida auris.

“Auris” means ear in Latin and is an appropriate name for this organism, which was discovered in the ear of a Japanese woman in 2009. Considered an oddity at the time, Candida auris quickly spread around the world, appearing a year earlier in Pakistan (2008), then subsequently in India (2009), Venezuela (2012), the United States and South Africa (2013), and Europe and Australia (2015).

Candida auris actually exists in at least four distinct genetic variants, leading researchers to believe that it has arisen independently in several different locations around the world.

Candida auris, a relatively new fungus, is a highly efficient killer.

Candida auris is not, however, just another fungus. It has proven to be highly resistant to many antifungal drugs. It spreads rapidly through hospitals, nursing homes and long-term care facilities where it proves difficult, if not almost impossible to eradicate. More common in weakened and susceptible patients, it kills nearly half of those infected within 90 days

.

Evolution and control

Where did this horror come from (besides from the ear of a Japanese woman) and what can be done to control or eliminate it?

Fungal specialists believe that our widespread use of antifungal agents has gradually resulted in the evolution of this previously harmless fungus. Much like the widespread use of antibiotics has caused the evolution of multiple drug-resistant bacteria, antifungal agents have created an environment favorable to the development of fungi that are immune to most antibiotics.

With antifungal agents so widely used in agriculture, resistant fungi will reproduce and flourish. It is not exactly survival of the fittest, but more precisely survival of the most adaptable. Candida auris appears to be one of these highly adaptable organisms.

We cannot easily produce new antifungal agents, nor can we eliminate the use of fungicides (or antibiotics) for agricultural purposes. It may come down to the same principle of highly selective use which has already been applied to antibiotics. Fungicides can be restricted or outlawed, even though the consequences on agricultural production may be dramatic.

For example, the fungus that destroyed the potato harvests in Ireland in the 1840s led to widespread crop failures, disease and famine. The same could occur with a new resistant fungus in our time that could wipe out wheat or rice harvests. Possible reductions in agricultural productivity must be weighed against the dangers posed by these new organisms.

Source: CDC

What comes next?

We can restrict our use of both antifungal and antibiotic agents to circumstances when they are truly required. Hospital infectious disease practitioners must add Candida auris to their already long list of resistant organisms they need to identify, track and eliminate in the hospital, long-term care and nursing home settings.

We are all engaged in this intense battle between humankind and the world's microorganisms, whether they be fungal or bacterial. Common sense must prevail or we will become victims of these horrific microscopic organisms that may kill with impunity because there is nothing available to use against them.

Learn more about Candida auris here.

Extreme heat is dangerous

By DR. MARTHA WHYTE | Region 7 Medical Director, Office of Public Health

With temperatures being in the 90s for most of this month, and with heat indexes in the triple digits, Louisiana is facing an extreme heat wave. Although most people understand that it is hot outside and even hear warnings about the risks of high heat, truly understanding and the dangers and taking the necessary precaution is important to prevent heat-related illness and death. Here are some key facts:

You’re always somebody’s type when it comes to blood donation

No matter your blood type, your blood donation can help save a life.

Blood transports oxygen and nutrients to the lungs and tissues, forms clots to prevent excess blood loss, carries cells and antibodies that fight infection, transports waste products to the kidneys and liver for filtering, and regulates body temperature. It is composed of four main building blocks.

• PLASMA is the main component of the blood, made up of water, sugar, fat, protein and salts. Its primary job is transporting blood cells throughout the body along with other things like antibodies, hormones, nutrients and more.
• RED BLOOD CELLS are the most plentiful cell in the blood and carry hemoglobin, which gives blood its red color. Hemoglobin helps carry oxygen from the lungs into the rest of the body, returning carbon dioxide to the lungs to be exhaled.
• WHITE BLOOD CELLS fight off infection. There are two types: neutrophils, which respond immediately to infection, and lymphocytes, which regulate the function of other immune cells, attack infected cells and tumors and make antibodies.
• PLATELETS are small fragments of cells that help with blood clotting.

Who needs blood donations?

When people think of who benefits from blood donations, typically they think of situations such as a car accident. Obviously, someone who has been severely injured in a car accident is likely to receive blood, but do you know who else needs donated blood?

• CANCER PATIENTS: Certain cancers and cancer treatments prevent patients from producing their own platelets, a component of the blood.
• TRAUMA AND SURGERY PATIENTS: Red blood cells carry oxygen throughout the body, so blood is frequently given to trauma and surgery patients, including women with pregnancy- and childbirth-associated bleeding.
• SICKLE CELL PATIENTS: People with sickle cell disease require frequent blood transfusions that must be closely matched to the donor’s blood type, usually from the same racial and ethnic group. Most people in the United States who have sickle cell disease are of African ancestry, but it’s also common in people of Hispanic ancestry.
• BURN PATIENTS: Plasma, another component of blood, is important to burn patients because it helps maintain blood pressure and other vital functions.
• PATIENTS WITH CHRONIC DISEASES: Patients with certain conditions in which the body does not make blood properly, such as hemophilia or anemia, may require frequent transfusions.

Every few seconds somebody is in need of a blood transfusion, making it vital that we have a safe, quality, sufficient supply available at all times. That’s where you, the donor, comes in.

Just your type

Before getting into the donation process, let’s talk about blood types. Some are rarer than others, making them in high demand, but all types are needed for donation.

The four major blood groups are A, B, AB and O; each group breaks down further into subgroups of A+, A-, B+, B-, O+, O-, AB+ and AB-. The + or - refer to a protein called the Rh factor, which can be present (+) or absent (-). Your blood group and presence or lack of an Rh factor determines your blood type.

Because not all blood types are compatible, it’s important during a transfusion that a person receives the right type of blood. If you accidentally receive the wrong blood type, your body could have a dangerous immune response like blood clumping, which can be fatal.

Typically, if you are in need of blood you will be given the type that matches yours, but sometimes that’s not possible. In that case, the universal red cell donor is O-, which means O- blood can be given safely to anyone regardless of blood type. That puts O- in high demand since it’s used for emergency transfusions and infants with compromised immunity, though O+ is also in high demand because it’s the most common blood type.

The universal plasma donor is AB.

How to save a life

So, you’re ready to donate? A single blood donation can save up to three lives! Type “blood donation centers near me” into your preferred internet search engine to find locations where you can donate. The major blood banks in Louisiana are The Blood Center, LifeShare, Vitalant (formerly United Blood Services), Our Lady of the Lake Blood Donor Center and Ochsner Blood Bank. Then, schedule an appointment.

Here’s what you can expect if you’re a first-time donor of whole blood. First, remember to plan ahead: have at least 16 ounces of water and a healthy meal before your appointment, and wear a shirt with sleeves that you can roll up.

When you arrive for your appointment, you’ll get registered — so bring your ID — then go over some basic eligibility requirements and receive information about donating blood. You’ll undergo a short interview about your health history, travel history, prescriptions and medications, as well as checks of your temperature, pulse, blood pressure and hemoglobin level.

Now, it’s time for the draw. You’ll either be seated or lie down, and then an area will be cleaned on your arm and a new, sterile needle will be inserted. It takes about 8 to 10 minutes to complete the blood draw, during which you may be given a ball to squeeze regularly to keep the blood flowing. When a pint of blood has been collected, the needle will be removed and your arm will be bandaged.

With that done, it’s time for a snack and something to drink, which will help replenish the loss of your body’s fluid following the blood donation. After a brief rest of 10 to 15 minutes, you can continue on with your day. Staff at the blood donation center may provide after-donation tips as well, such as drinking plenty of water and eating foods rich in iron. You must wait at least eight weeks between donations of whole blood.

Blood donation is a short, simple process that saves lives — and hey, there’s free snacks! Are you ready to be a lifesaver?

What’s for lunch? Get your child ready for the school cafeteria

By EMILY PINEDA | School Health/Early Childhood Education Manager, Well-Ahead Louisiana and ANGELA VANVECKHOVEN | Health Education Manager, Well-Ahead Louisiana

Getting your children ready to go back to school includes getting supplies, buying new clothes, learning bus routes and many other details. You might not think about what is being served in the cafeteria, but many Louisiana students eat both breakfast and lunch at school, so it’s an important part of your child’s day. 

Here are some questions to ask and things to think about as your kids head back to the school cafeteria.

What is my child’s school cafeteria serving?

Review the cafeteria menu with your child. Menus often list alternate choices, such as entrée salads and sandwiches, available to students who don’t care for the daily special. Ask your children about the fruit and vegetable choices offered with each meal, and encourage them to try new things.

If you want more information, many school nutrition departments have a page on the school district’s website that lists ingredients, nutritional facts and allergen information.

Finally, make plans to have lunch with your child in their cafeteria, and see for yourself how the meal looks, smells and tastes.

Who should I contact with questions or concerns about the school cafeteria menu?

The school’s cafeteria manager can talk with you about anything from meal preparation to how long students wait in line for their food. If you have more detailed questions, the cafeteria manager may refer you to the nutrition director, who oversees cafeteria operations, food procurement and menu planning for the entire school district. Also, be sure to ask your child’s teacher about classroom policies regarding food rewards and items served during classroom parties.

How can I get involved in my child’s school meal program?

Ask the cafeteria manager and principal about volunteer opportunities in your school cafeteria or school garden, if there is one. Some schools request parent volunteers to help usher students through the lunch line and encourage them to try their fruits and vegetables.

Additionally, all school districts have an advisory council and wellness policy to help establish and update district nutrition and physical activity policies. These policies can affect such things as the choices available in vending machines and the amount of time allotted each week for physical education, among others.

My child has food allergies. Do school cafeterias accommodate special dietary requirements, such as being gluten-free or nut-free?

If your child has a life-threatening food allergy, it is important to build a team of key individuals at school who can help safely manage his or her needs. Start by contacting your school nurse to discuss implementing an allergy action plan. The school nurse can work with parents and healthcare providers to develop a healthcare plan to meet the unique needs of each student.

Is my child’s school a WellSpot?

In and out of the cafeteria, schools make a major impact in the health of children. Schools designated as WellSpots make the well-being of their students and staff a priority.  School WellSpots meet benchmarks that are centered on a campus-wide tobacco-free policy and a school wellness program that includes physical activity and nutrition components for both students and staff. 

To learn more about how School WellSpots make the healthy choice the easy choice, visit Well-Ahead Louisiana’s School WellSpot page and share it with your child’s school.

For more information

To learn more about school health, visit Well-Ahead Louisiana’s website or email wellahead@la.gov.

Louisiana’s hepatitis C subscription model: ‘We were going to fix this problem’

In case you missed it, Louisiana Department of Health Secretary Dr. Rebekah Gee sat down with the Brookings Institution on July 22 to discuss the Department’s plan to use a subscription model to obtain expensive hepatitis C drugs. The plan has generated considerable interest given the innovative use of a model that Dr. Gee has said could help Louisiana cure the disease for thousands of patients.

If you missed the video coverage of the panel discussion featuring Dr. Gee, you can find a transcript of it here. 

At left is Louisiana Department of Health Secretary Dr. Rebekah Gee.

Dr. Gee discussed how difficult it was to find a way around the expensive hepatitis C drugs, but told Brookings moderator Louise Sheiner that “as long as I had the ability to have this role and to fight for the people of my state, and my Governor, we were not going to take ‘No.’ We were going to fix this problem.”

“The goal,” Dr. Gee added, "is to treat everybody with this virus.”

About 90,000 people in Louisiana have viral positives for hepatitis C and in the Medicaid program, there’s about 37,000.

The event drew media attention for the focus on prescription drug prices, which is a topic the U.S. Congress is expected to take up in September.

The Washington Times reported that Neeraj Sood, a University of Southern California professor of public policy, told the panel that Louisiana’s idea is to “give these profits upfront to the pharmaceutical firm but also dramatically improve access because price is not a barrier.”

The Baton Rouge Advocate wrote that Dr. Gee said during the panel discussion that the focus was in helping Medicaid recipients and prisoners at risk of dying of the disease.

“These are vulnerable populations,” The Advocate quoted Dr. Gee as saying. “We have to think outside the box."

And The Center Square noted that Dr. gee considered the subscription model a "win-win" that will "provide unlimited access of the drug to prisoners and Medicaid recipients at a cost of up to $58 million, which is about what the state spent last fiscal year to treat far fewer people with the same drug."

How to talk to your children following a mass shooting

Author: Danita Leblanc, LCSW-BACS, State Suicide Prevention Coordinator

Restoring a sense of safety for your children in the aftermath of a mass shooting, especially one at a school, may be difficult as a parent. Too often our children are exposed to violence that is both senseless and harmful. Many children, those living in close proximity to a tragic event, and those who will learn about the event through television, social media, or newspaper coverage, will be affected and upset.

Children and teens may react differently to the shooting depending on their age and prior experiences, and parents should expect that youth may respond in different ways, and be supportive and understanding of different reactions, even when you are having your own reactions and difficulties.

Common Reactions

Many emotions will be evoked by this tragedy – sadness, grief, helplessness, anxiety, and anger. Children who are struggling with their thoughts and feelings with the stories and images of the shooting may turn to adults for help and guidance. Knowing some of the common reactions can help you be supportive both of yourself and your children. The National Child Traumatic Stress Network recommends looking for the following reactions: 

• Feelings of anxiety, fear, and worry about the safety of self and others
• Fears that another shooting may occur
• Change in behavior:
• Increase in activity level
• Decrease in concentration and attention
• Increase in irritability and anger
• Sadness, grief, and/or withdrawal
• Radical changes in attitudes and expectations for the future
• Increases or decreases in sleep and appetite
• Engaging in harmful habits like drinking, using drugs, or doing things that are harmful to self or others
• Lack of interest in usual activities, including how they spend time with friends
• Physical complaints (headaches, stomachaches, aches, and pains)
• Changes in school and work-related habits and behavior with peers and family
• Staying focused on the shooting (talking repeatedly about it)
• Strong reactions to reminders of the shooting
• Increased sensitivity to sounds

The Centers for Disease Control and Prevention lists such events as the type of occurrence which cause Post-traumatic Stress Disorder in children. Examples of symptoms of PTSD can be found on the CDC’s webpage, which also includes treatment options for PTSD.

Start the Conversation

It is important to talk about the shooting with your child. Not talking about it can make them seem even more threatening in your child’s mind, and silence suggests that what has occurred is too horrible even to speak about or that you do not know what has happened. With social media, it is highly unlikely that children and teenagers have not heard about it. Chances are your child has heard about it, too.

Start by asking what your child already knows about the event either from the media or from their friends. Listen carefully and try to figure out what he or she knows or believes. As he or she explains, listen for misinformation, misconceptions and underlying fears or concerns. Understand this information will change as more facts about the shooting are known.

With a high profile event of this magnitude, which can result in confusion or distress among communities across the country, it is important that parents communicate effectively with their children.

For more information on how to talk to your children about this shooting, or any other tragic event, NCTSN has compiled a list of tips to help you help your children with their thoughts and feelings, which can be found here.

Answers to some common questions

Children will undoubtedly have many questions when asking caregivers about a confusing or senseless act of mass violence.

Why do these things happen?

Often, children, like adults, want to know the motives of the people responsible for these horrible events. Past events have resulted from many causes including mental illness, rage, extreme political or religious beliefs, and hatred. Unfortunately, there usually isn’t a concrete answer to why a specific individual acted in such a way. It does not help children to have them fear groups of people who fall into any specific demographic category. Doing so only leads to discrimination, stigma, and victimization of people who are also struggling to cope with these events. More importantly, help your children understand that adults, including government authorities, work hard to identify and stop dangerous events before they ever happen.

Will this happen again and how do I keep my children safe?

Unfortunately, violent events are likely to happen again. It is important to remember that despite our awareness, random acts of violence occur rarely and does not occur in most neighborhoods. Remember that parents and professionals strive to keep our children safe yet allow them the space they need to grow and develop.

Use the guidelines that can be found here to keep your child safe.

There are a number of things you can do for your child and yourself to help restore a sense of safety in your home. A list of those things can be found here. 

Add wellness exams to your back-to-school list

By DR. DAWN MARCELLE | LDH Region 2 Medical Director

The dawn of a new school year sees parents loading up on pencils, paper and all the trappings needed for their children’s academic success. But does that checklist make room for health? Along with up-to-date immunizations, the beginning of the school year is the perfect time for a variety of checkups.

Physical exams

Schedule an appointment with your family’s pediatrician for a wellness checkup. Your pediatrician will give your child a physical examination including height, weight, blood pressure, heart rate, reflexes, scoliosis (abnormal curvature of the spine) and a check of the eyes, ears, nose, mouth and skin for abnormalities.

This exam is also a great time to talk about any concerns you may have about your child’s health, including diet/nutrition, sleep and behavior.

If your child participates in sports, your pediatrician will perform a sports physical. The Louisiana High School Athletic Association, or LHSAA, mandates all student athletes to pass a sports physical as part of its participation requirements. Sports physical forms can be downloaded here.

Immunizations

During the wellness checkup, your pediatrician will make sure your child is up to date on immunizations. Common immunizations among school-age children include TdaP (tetanus, diphtheria and pertussis), varicella (chickenpox), MMR (measles, mumps, rubella), hepatitis B, polio and meningococcal.

Children who are Medicaid eligible, uninsured or of American Indian or Alaskan Native descent may be eligible to receive vaccines at no charge through the Vaccines for Children Program, a service offered through the Immunization Program within the Louisiana Department of Health’s Office of Public Health.

Beginning this school year, LDH is making it easier for parents to review and print their children’s vaccination records with LA MyIR. This website lets you access your family’s official immunization records at any time, from any device and at no cost.

Vision testing

A child who can’t see well is going to have problems in the classroom. Some schools conduct vision screenings, but that may not be enough to spot problems. You may be surprised to learn that the American Optometric Association says these screenings miss up to 75% of children with vision problems.

Signs that a child may be having problems with their sight include covering one eye, holding reading materials close to the face, squinting, a short attention span and complaints about headaches or other discomfort.

Schedule a comprehensive eye and vision examination with a doctor of optometry. The optometrist has access to specialized equipment and procedures to fully assess your child’s vision. Click here to find an optometrist near you.

Hearing tests

Babies have their hearing tested a few weeks after birth, but that doesn’t mean it should be the last time hearing is checked. Hearing loss is usually a gradual process, happening over time. If your child isn’t responding to a teacher’s instructions, it may be because their hearing is suffering. Poor hearing can affect speech development and even social development, since a child who can’t hear well may have problems interacting with other people.

The American Academy of Pediatrics recommends hearing screenings at school entry for all children; at least once during ages 6, 8 and 10; at least once during middle school; at least once during high school; and for any student entering a new school system without evidence of a previous hearing screening. Ask your pediatrician for a recommendation if your child needs a screening.

Dental exams

Many children drop their usual dental habits during the carefree days of summer. Get them back on track with a dental exam and cleaning. Your dentist will make sure your child’s teeth are strong and straight, their bite is in good shape and check for any problems such as cavities or gum disease.

Children who play year-round sports should bring their mouth guards along to the exam. Dental staff will check the guard for wear, tear and fit. Growing children may be fitted for a new guard if they are outgrowing the old one.

You can learn more about LDH’s efforts to provide healthy smiles here, and the American Dental Association offers an online Find-a-Dentist tool here.

Healthy eating

Of course, you can’t send the kids back to school without a nutritious lunch. Check the LDH Blog next week for tips on healthy eating in the school cafeteria.